Urakami A, Hirai R, Ota T, Soga H, Nawa S, Shimizu N
Second Department of Surgery, Okayama University Medical School, Japan.
Acta Med Okayama. 1996 Dec;50(6):285-92. doi: 10.18926/AMO/30481.
An experiment was conducted to determine whether the oxygen and carbon dioxide gas tensions in liver tissue (PtO2 and PtCO2, respectively) reflect the state of microcirculation and/or metabolism in the ischemic liver. Subjects were divided into three groups: group 1, 30 min ischemia; group 2, 60 min ischemia; group 3, four times of intermittent 15 min ischemia after every 10 min of reperfusion. PtO2, PtCO2 and tissue blood flow (TBF) were measured by mass spectrometry, comparatively studied with the serum GOT level as an indicator of liver tissue damage. Furthermore, the time point at which the PtCO2 increase for 1 min initially became less than 1/2 of the maximum value was located on the transit curve of PtCO2, referred to as the critically anaerobic (CA) point, with which new indices of critically anaerobic score (CAS) and time (CAT) (see details in text) were developed. The profiles of PtO2 and PtCO2 during ischemia and reperfusion were clearly demonstrated, and the CA point was observed 12.7 +/- 2.9 min after induction of ischemia. PtO2 was positively correlated with TBF and negatively with the serum GOT level. Furthermore, not only CAS but also CAT were significantly correlated with PtO2, TBF, and the serum GOT level. It was concluded that PtCO2 reflects the state of anaerobic tissue metabolism during ischemia and PtO2 reflects the magnitude of microcirculatory disturbance and tissue injury caused by ischemia/reperfusion. Therefore, continuous monitoring of not only PtO2 but also PtCO2 is beneficial for patients undergoing hepatic surgery with ischemia.
进行了一项实验,以确定肝组织中的氧气和二氧化碳气体分压(分别为PtO2和PtCO2)是否反映缺血肝脏中的微循环和/或代谢状态。将受试者分为三组:第1组,缺血30分钟;第2组,缺血60分钟;第3组,每10分钟再灌注后进行4次间歇性15分钟缺血。通过质谱法测量PtO2、PtCO2和组织血流量(TBF),并以血清谷草转氨酶(GOT)水平作为肝组织损伤指标进行比较研究。此外,在PtCO2的过渡曲线上确定PtCO2在1分钟内最初增加量小于最大值的1/2的时间点,称为临界无氧(CA)点,并据此建立了新的临界无氧评分(CAS)和时间(CAT)指标(详见正文)。清晰显示了缺血和再灌注期间PtO2和PtCO2的变化情况,缺血诱导后12.7±2.9分钟观察到CA点。PtO2与TBF呈正相关,与血清GOT水平呈负相关。此外,不仅CAS而且CAT都与PtO2、TBF和血清GOT水平显著相关。得出的结论是,PtCO2反映缺血期间无氧组织代谢状态,PtO2反映缺血/再灌注引起的微循环紊乱和组织损伤程度。因此,对接受肝脏缺血手术的患者不仅持续监测PtO2而且持续监测PtCO2是有益的。